Provider Demographics
NPI:1699980615
Name:MARLOWE, KIMBERLY J (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:J
Last Name:MARLOWE
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:J
Other - Last Name:KOTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8200 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-9503
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8200 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-9503
Practice Address - Country:US
Practice Address - Phone:316-721-4544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-12
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04350472085R0202X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS110623003Medicare PIN